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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2015; 7(4): 17-29
Published online Apr 15, 2015. doi: 10.4251/wjgo.v7.i4.17
Cancer cachexia, mechanism and treatment
Tomoyoshi Aoyagi, Krista P Terracina, Ali Raza, Hisahiro Matsubara, Kazuaki Takabe
Tomoyoshi Aoyagi, Krista P Terracina, Ali Raza, Kazuaki Takabe, Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, United States
Tomoyoshi Aoyagi, Hisahiro Matsubara, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba 263-0022, Japan
Author contributions: All the authors generated the ideas and contributed to the writing of this paper.
Supported by NIH, No. R01CA160688 and No. T32CA085159-10.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kazuaki Takabe, MD, PhD, FACS, Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, West Hospital 7-402, 1200 East Broad Street, Richmond, VA 23298-0011, United States. ktakabe@vcu.edu
Telephone: +1-804-8289322 Fax: +1-804-8284808
Received: October 21, 2014
Peer-review started: October 25, 2014
First decision: December 17, 2014
Revised: January 17, 2015
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: April 15, 2015
Processing time: 129 Days and 4.1 Hours
Abstract

It is estimated that half of all patients with cancer eventually develop a syndrome of cachexia, with anorexia and a progressive loss of adipose tissue and skeletal muscle mass. Cancer cachexia is characterized by systemic inflammation, negative protein and energy balance, and an involuntary loss of lean body mass. It is an insidious syndrome that not only has a dramatic impact on patient quality of life, but also is associated with poor responses to chemotherapy and decreased survival. Cachexia is still largely an underestimated and untreated condition, despite the fact that multiple mechanisms are reported to be involved in its development, with a number of cytokines postulated to play a role in the etiology of the persistent catabolic state. Existing therapies for cachexia, including orexigenic appetite stimulants, focus on palliation of symptoms and reduction of the distress of patients and families rather than prolongation of life. Recent therapies for the cachectic syndrome involve a multidisciplinary approach. Combination therapy with diet modification and/or exercise has been added to novel pharmaceutical agents, such as Megestrol acetate, medroxyprogesterone, ghrelin, omega-3-fatty acid among others. These agents are reported to have improved survival rates as well as quality of life. In this review, we will discuss the emerging understanding of the mechanisms of cancer cachexia, the current treatment options including multidisciplinary combination therapies, as well an update on new and ongoing clinical trials.

Keywords: Physical exercise; Pharmacological treatment; Cancer cachexia

Core tip: This review aims to present the clinical presentation, the mechanisms, and current treatment options, such as pharmacological treatment and physical exercise for cancer cachexia.